The Only Lean Path is an Unclear Path?

I've been fortunate and grateful that my book, Lean Hospitals, has received good reviews on Amazon:
  • 5 Star Reviews = 11
  • 4 Star Reviews = 1
This week, I got my first “3 Star” review. That's fine, I'm not too sore about it really. It happens when there are that many reviews, not everyone is going to love the book. At least nobody hates it enough to go out of their way to write a “1 Star” review.
The review said this:

This book provides an introduction to lean methodology and how it might apply in a healthcare environment. It is presented in an easy to read format but doesn't really tell you how you might go about introducing lean in your own hospital.

Ok, fair enough that it's not a detailed how-to guide. I try to cover how to get started (Chapter 11) — so that probably covers how to “introduce” lean to an organization. It doesn't say this on the Amazon page (glowing publisher-produced descriptions), but on my own personally-produced page for the book, I state pretty clearly that the book is an introduction to concepts and examples — not a detailed how-to guide. But not everyone sees that warning, I guess.

The book is not intended as a detailed “how to” implementation guide. It is meant to be an overview that covers topics…

I'm sorry that reader was disappointed. I tweeted about it and somebody wrote back and said that too many people want a simplistic road map that they can follow — and those don't exist.

It sounds like a bit of an excuse, but I think it's true. That's why it's sometimes called the “Thinking Production System” — you have to think. You can't just copy others, as Bill Waddell blogged about yesterday.

Coincidentally, I was flipping through a new book at the LEI office yesterday, Mike Rother's Toyota Kata: Managing People for Improvement, Adaptiveness and Superior Results. Right in chapter 1, he talks about how there is no perfect plan for becoming truly lean.

He uses this diagram:

“If we think this is clear, then we are only in implementation mode,” says Rother. He draws a distinction between implementing tools and becoming truly lean as an organization.

Rother says:

“We will not be successful in the Toyota style until we adopt more of a do-it-yourself problem-solving mode.”

But I guess there are a lot of consultants who want to sell their services as a way to tell you how to do it… many clients and organizations want that, regardless of your industry, right?

How does your organization (or your consultant) balance learning from Toyota and thinking to develop your own plan versus just copying or following a rote roadmap.

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Unfortunately, I believe a lot of folks just want the quick and easy "Tell me how to do it" approach, and if so, I'd argue Lean isn't right for them. They'd probably seek consultants of the "Lean Ninja" style who will swoop in and "get them Lean" in a year (not going to happen, as well all know), which tosses their Lean initiative onto the flavor of the month scrap heap, resulting in employees thinking that Lean doesn't work. On the other hand, consultants have an obligation to cover the fundamentals/basics very well, and then actively challenge the organization to think and grow – teach them to fish.

    I've directly observed consultants who KNOW their client isn't doing their part to grow and commit yet refrained from bringing it to their attention – fear creeps in (don't want to upset the customer, lose the account, lose my job). Are these consultants working for companies that are actually Lean themselves?!?! Dollars over integrity – it's the American way when you're packaging & selling.

    Oh, and about the 3-star review… Think of it this way… There actually were people who didn't like the Beatles, either (I wasn't one of them.)

  2. You should see my "2-star" review on the UK Amazon site:


    I'm not that bent out of shape about either review, honestly. It's interesting to see the perspectives.

    I've gotten a lot of feedback from hospital executives that my book helped them understand that Lean is not just about tools. Yet the UK review thrashes me for being a "tool head" as the John Seddon crowd would say.

  3. Take it as a badge of honor to ripped by a "Seddon-head."

    John Seddon's books are great, but he's an old crank. He even called Womack a "tool head" recently, which is just ignorant.

    The Seddon heads come across as the smartest kids in the room, nobody else gets it like they do and that's, frankly, obnoxious.

    I should say as much in a review of his book, but I'll save the time. It's not worth it, really.

  4. Who the H-E double toothpicks is John Seddon & the Seddonheads? (Sounds like a punk band that tanked in the 80's.)

    There, that gives an idea as to how much he and his groupies' opinions matter.

    Honestly, I'd never heard of him/them until just now…

  5. As an internal consultant we are striving to help "adopt more of a do-it-yourself problem-solving mode".

    The common tension is when a lot of leaders keep trying to push for implementation mode. I have heard more than a few requests of "Just do that" or "copy what I saw here".

  6. I do like John Seddon's work. He's a Deming disciple, in the UK. He's probably more well known there than in the U.S.

    His "Freedom from Command and Control" is a good read. John does most of his work on the services (government) side of things. He prefers to call it "systems thinking" instead of Lean, it seems.

    All trying to win the same war. Avoiding civil wars in the middle of this is probably good.


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